Burden of smoking on quality of life in patients with chronic obstructive pulmonary disease.

The objective of this study was to assess the impact of smoking on health-related quality of life, Work Productivity and Activity Impairment (WPAI) in chronic obstructive pulmonary disease (COPD) patients. Respondents of the 2009/2010 US National Health and Wellness Survey (NHWS), aged ≥ 40 years, with COPD, chronic bronchitis or emphysema, were included in the study. Current and former (had not smoked for ≥ 11 years) smokers were compared. Physical component summary (PCS) and mental component summary (MCS) scores from the Short Form-12 version 2 (SF-12v2), health utilities (SF-6D) and WPAI were evaluated. Differences between current (n = 1685) and former (n = 1932) smokers were revealed: MCS (44.80, 46.73; p < 0.01); PCS (35.12, 35.79; p < 0.1); SF-6D (0.63, 0.65; p < 0.05). WPAI: presenteeism (23%, 18%; p < 0.05); work impairment (25%, 21%; p < 0.05); activity impairment (52%, 49%; p < 0.01). In conclusion, COPD patients who smoke have poorer health-related quality of life, impaired productivity and higher healthcare costs than former smokers.

Exacerbations among chronic bronchitis patients treated with maintenance medications from a US managed care population: an administrative claims data analysis.

PURPOSE: Chronic obstructive pulmonary disease (COPD) exacerbations are the leading cause of hospital admission and death among chronic bronchitis (CB) patients. This study estimated annual COPD exacerbation rates, related costs, and their predictors among patients treated for CB. METHODS: This was a retrospective study using claims data from the HealthCore Integrated Research Database (HIRD(SM)). The study sample included CB patients aged ≥ 40 years with at least one inpatient hospitalization or emergency department visit or at least two office visits with CB diagnosis from January 1, 2004 to May 31, 2011, at least two pharmacy fills for COPD medications during the follow-up year, and ≥2 years of continuous enrollment. COPD exacerbations were categorized as severe or moderate. Annual rates, costs, and predictors of exacerbations during follow-up were assessed. RESULTS: A total of 17,382 individuals treated for CB met the selection criteria (50.6% female; mean ± standard deviation age 66.7 ± 11.4 years). During the follow-up year, the mean ± standard deviation number of COPD maintenance medication fills was 7.6 ± 6.3; 42.6% had at least one exacerbation and 69.5% of patients with two or more exacerbations during the 1 year prior to the index date (baseline period) had any exacerbation during the follow-up year. The mean ± standard deviation cost per any exacerbation was $269 ± $748 for moderate and $18,120 ± $31,592 for severe exacerbation. The number of baseline exacerbations was a significant predictor of the number of exacerbations and exacerbation costs during follow-up. CONCLUSION: Exacerbation rates remained high among CB patients despite treatment with COPD maintenance medications. New treatment strategies, designed to reduce COPD exacerbations and associated costs, should focus on patients with high prior-year exacerbations.

Healthcare utilization and costs among chronic bronchitis patients treated with maintenance medications from a US managed care population.

OBJECTIVES: This study aimed to examine the real-world healthcare resource utilization (HCRU) and direct costs among chronic bronchitis (CB) patients treated with chronic obstructive pulmonary disease (COPD) maintenance medications. METHODS: This retrospective analysis utilized administrative claims data from 14 US commercial managed care plans. Eligible patients were ≥40 years old, had ≥2 years of continuous enrollment, ≥1 CB (ICD-9-CM code 491.xx) hospitalization or emergency department (ED) visit or ≥2 office visits between 1/1/2004 and 5/31/2011, and had ≥2 pharmacy fills for COPD medications during follow-up (first fill served as the index date). All-cause and COPD-related HCRU and costs were assessed during follow-up. Multivariate models were utilized to identify predictors of total costs. RESULTS: Treated CB patients (n = 17,382; 50.6% female; mean age 66.7 (SD = 11.4) years) had a mean of 7.6 (SD = 6.3) COPD maintenance medication fills during follow-up. Overall, 32.6% of patients had ≥1 COPD-related inpatient hospitalizations, 12.9% had ≥1 ED visit, and 81.8% had ≥1 office visit. Mean all-cause and COPD-related total costs were $25,747 (SD = $51,105) and $12,609 (SD = $36,801), respectively, during follow-up. Among the sub-group with ≥1 exacerbation during baseline year, 42.3% had ≥1 COPD-related inpatient hospitalization, 18.5% had ≥1 ED visit, and 88.2% had ≥1 office visit. Mean follow-up all-cause and COPD-related total costs were $29,861 (SD = $49,799) and $16,784 (SD = $34,170), respectively. The number of baseline exacerbations was a significant predictor of all-cause and COPD-related total costs during follow-up. LIMITATIONS: This study lacked standard measures of CB severity; however, severity proxies were utilized. CONCLUSION: HCRU and costs among CB patients were substantial during follow-up, despite treatment with COPD maintenance medications. Additional interventions aiming to prevent or reduce HCRU and costs among CB patients warrant exploration.

Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population.

BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) lead to significant increases in resource utilization and cost to the health care system. COPD patients with chronic bronchitis and a history of exacerbations pose an additional burden to the system. This study examined health care utilization and cost among these patients. METHODS: For this retrospective analysis, data were extracted from a large national health plan with a predominantly Medicare population. This study involved patients who were aged 40-89 years, had been enrolled continuously for 24 months or more, had at least two separate insurance claims for COPD with chronic bronchitis (International Classification of Diseases, Ninth Revision, Clinical Modification code 491.xx), and had pharmacy claims for COPD maintenance medications between January 1, 2007, and March 31, 2009. Two years of data were examined for each patient; the index date was defined as the first occurrence of COPD. Baseline characteristics were obtained from the first year of data, with health outcomes tracked in the second year. Severe exacerbation was defined by COPD-related hospitalization or death; moderate exacerbation was defined by oral or parenteral corticosteroid use. Adjusted numbers of exacerbations and COPD-related costs per patient were estimated controlling for demographic and clinical characteristics. RESULTS: The final study sample involved 8554 patients; mean age was 70.1±8.6 years and 49.8% of the overall population had exacerbation, 13.9% had a severe exacerbation only, 29.1% had a moderate exacerbation only, and 6.8% had both a severe and moderate exacerbation. COPD-related mean annual costs were $4069 (all figures given in US dollars) for the overall population and $6381 for patients with two or more exacerbations. All-cause health care costs were $18,976 for the overall population and $23,901 for patients with history of two or more exacerbations. Severity of exacerbations, presence of cardiovascular disease, diabetes, and long-term oxygen use were associated with higher adjusted costs. CONCLUSIONS: The results indicate that despite treatment with maintenance medications, COPD patients continue to have exacerbations resulting in higher costs. New medications and disease management interventions are warranted to reduce the severity and frequency of exacerbations and the related cost impact of the disease.

Economic burden of chronic bronchitis in the United States: a retrospective case-control study.

BACKGROUND: Chronic bronchitis (CB) is often misdiagnosed or diagnosed at a later stage of chronic obstructive pulmonary disease (COPD). We examined how this later diagnosis may impact health care costs and utilization during the 12 months prior to and 24 months post initial CB diagnosis. METHODS: This retrospective case-control analysis used claims data from a large US database from July 1, 2003 through June 30, 2007. Patients with CB aged 40 years and older were propensity matched (N = 11,674) to patients without evidence of COPD or asthma by demographics, CB diagnosis quarter/year, and comorbidities. Group differences were assessed using Student's t-test and Pearson chi-square test statistics. RESULTS: Six months prediagnosis, CB patients had higher frequencies of any hospitalization (9.6%, 6.7%; P < 0.05), emergency department/urgent care visits (13.3%, 6.7%; P < 0.05), and prescriptions (97.3%, 94.1%; P < 0.05). Six months postdiagnosis, CB patients had 5.6 times more hospitalizations (P < 0.05) and 3.1 times more emergency department/urgent care visits (P < 0.05) compared with controls. Mean total costs (US$) for CB patients 12 months prediagnosis were significantly higher than controls (months 12-7: $4212, $3826; P < 0.05; months 6-1: $5289, $4285; P < 0.05). CB patients had higher mean total costs ($8919; P < 0.05) 6 months postdiagnosis. Costs remained $2429 higher for CB patients 19-24 months postdiagnosis (P < 0.05). CONCLUSION: Health care costs and utilization among CB patients are increased both prior to diagnosis and during the 2 years postdiagnosis. This study suggests that not accurately diagnosing CB early has a substantial impact on health care costs, and that the economic burden for CB patients remains elevated even after adjustment for comorbidities associated with COPD.

Acute care costs of patients admitted for management of chronic obstructive pulmonary disease exacerbations: contribution of disease severity, infection and chronic heart failure.

BACKGROUND: In 2003, chronic obstructive pulmonary disease (COPD) accounted for 46% of the burden of chronic respiratory disease in the Australian community. In the 65-74-year-old age group, COPD was the sixth leading cause of disability for men and the seventh for women. AIMS: To measure the influence of disease severity, COPD phenotype and comorbidities on acute health service utilization and direct acute care costs in patients admitted with COPD. METHODS: Prospective cohort study of 80 patients admitted to the Royal Melbourne Hospital in 2001-2002 for an exacerbation of COPD. Patients were followed for 12 months and data were collected on acute care utilization. Direct hospital costs were derived using Transition II, an activity-based costing system. Individual patient costs were then modelled to ascertain which patient factors influenced total direct hospital costs. RESULTS: Direct costs were calculated for 225 episodes of care, the median cost per admission was AU$3124 (interquartile range $1393 to $5045). The median direct cost of acute care management per patient per year was AU$7273 (interquartile range $3957 to $14 448). In a multivariate analysis using linear regression modelling, factors predictive of higher annual costs were increasing age (P= 0.041), use of domiciliary oxygen (P= 0.008) and the presence of chronic heart failure (P= 0.006). CONCLUSION: This model has identified a number of patient factors that predict higher acute care costs and awareness of these can be used for service planning to meet the needs of patients admitted with COPD.

Gemifloxacin use in the treatment of acute bacterial exacerbation of chronic bronchitis.

The newest generation of fluoroquinolones have proven efficacy against bacterial organisms associated with acute exacerbation of chronic bronchitis (AECB). Gemifloxacin, as one of the quinolones in this class, exhibits many of the pharmacokinetic and pharmacodynamic characteristics of the class with a few notable differences. Against Streptococccus pneumoniae it has a lower minimal inhibitory concentration (MIC) than the other respiratory fluoroquinolones and it has activity against both bacterial DNA gyrase and topoisomerase IV. The increased activity of gemifloxacin against both enzymes may be associated with decreased rates of resistance. Clinically, gemifloxacin has been shown to have positive effects on length of hospitalization and increased success at long-term follow-up in AECB patients. These associations were observed in noninferiority comparison studies. Although an advantage with the use of gemifloxacin in AECB is suggested, there are no comparison data is available to conclude that gemifloxacin is superior to the other respiratory fluoroquinolones. Gemifloxacin is generally well tolerated, but is associated with a characteristic rash and gastrointestinal upset as its most common observed side effects.

Costs of treating lower respiratory tract infections.

OBJECTIVE: To determine the direct medical costs of treating lower respiratory tract infections (LRTIs) in a managed care organization (MCO). STUDY DESIGN: Retrospective analysis of a regional MCO identifying adults diagnosed with acute exacerbation of chronic bronchitis (AECB) or community- acquired pneumonia (CAP). METHODS: A claims database examination of International Classification of Diseases, Ninth Revision, Clinical Modification codes was conducted to identify adults receiving initial outpatient care for an LRTI during 2005-2006. Medical record review then was conducted to verify clinical diagnosis of AECB or CAP. Clinical and demographic data were collected. Outpatient office and clinic visits, hospitalization, and radiology, pathology, and pharmacy records were used to determine treatment costs. Treatment failure was determined by use of a second antibiotic course, follow-up emergency room presentation, or hospitalization for LRTI within 28 days of the index visit. The primary outcome was per-case treatment cost from the payer perspective. RESULTS: Clinical diagnosis was confirmed for 65 unique coded visits (60 patients; 39 with AECB, 22 with CAP; 1 in both cohorts). Initial visit, initial diagnostic testing, and subsequent hospitalization accounted for the majority (63%) of payer costs. Antibiotics were responsible for 15% of payer costs. Higher initial antibiotic expenditure in the AECB cohort yielded a cost-benefit ratio of 3:1. Mean per-case costs for success and failure were $277 & $372 for AECB, and $493 & $3019 for CAP, respectively. CONCLUSIONS: Initial visit and hospitalization costs contribute the majority of payer expenditure while antibiotic expenditure incurs a nominal burden. Higher expenditure on initial antibiotic therapy in the AECB population appears to be beneficial.

Factores de riesgo de elevado coste de las agudizaciones de la bronquitis crónica y la EPOC / Risk factors for increased cost of exacerbations of chronic bronchitis and Chronic Obstructive Pulmonary Disease

Objetivo: Identificar las variables de los pacientes, de las agudizaciones y del tratamiento de la bronquitis crónica (BC) y la enfermedad pulmonar obstructiva crónica (EPOC) que se asocian con un mayor coste sanitario directo. Método: Estudio observacional y farmacoeconómico en pacientes con BC y EPOC con agudización de probable etiología bacteriana, definida por presentar 2 o más de los criterios de Anthonisen. Se siguió a los pacientes durante 30 días y se evaluaron los costes directos derivados de su atención. El análisis estadístico se efectuó mediante regresión logística con cálculo de las odds ratio (OR) ajustadas, considerando variable dependiente un coste de agudización superior a los 150 €. Resultados: Participaron 252 médicos que recabaron información sobre 1.164 pacientes. Se recogieron todos los parámetros farmacoeconómicos en 947 pacientes (82,6%). En los primeros 30 días, 206 acudieron por mala evolución (21,8%), 69 (7,3%) requirieron atención en urgencias y 22 (2,3%) precisaron ingreso. Se clasificaron como de coste elevado (> 150 €) 101 agudizaciones (10,7%). Las variables que se asociaron a un coste elevado fueron la oxigenoterapia continua (OR = 7,58) y la hospitalización previa (OR = 2,6), mientras que el diagnóstico de BC (OR = 0,41) y el tratamiento de la agudización con moxifloxacino o amoxicilina-ácido clavulánico, comparado con claritromicina (OR = 0,38), se asociaron a un coste bajo. Conclusión: Un 21,8% de los pacientes con agudización de la BC y EPOC fracasa, con lo que se genera un coste mayor, fundamentalmente por nuevas visitas médicas y solicitud de pruebas complementarias. Las variables que se asocian a una agudización de coste elevado son la oxigenoterapia continua, la hospitalización previa y el tratamiento con claritromicina comparada con moxifloxacino o amoxicilina-ácido clavulánico

Objective: To identify what variables characterizing the patients, exacerbations, and treatment of chronic bronchitis and chronic obstructive pulmonary disease (COPD) are associated with a higher direct health cost. Method: Observational pharmacoeconomic study of exacerbations of chronic bronchitis and COPD (of probable bacterial etiology, defined as Anthonisen types I or II). Direct health costs were assessed during 30 days of follow-up. Logistic regression was employed for statistical analysis, with calculation of the adjusted odds ratios (OR). An exacerbation cost greater than €150 was defined as the dependent variable. Results: Data on 1164 patients were collected by 252 physicians. Pharmacoeconomic data were complete in 947 patients (82.6%). In the first 30 days, 206 sought medical attention because of unsatisfactory response to treatment (21.8%), 69 (7.3%) attended the emergency room, and 22 (2.3%) were admitted to hospital. Overall, 101 exacerbations (10.7%) were classified as high cost (> €150). Continuous oxygen therapy (OR=7.58) and previous hospitalization (OR=2.6) were associated with high-cost exacerbations, whereas diagnosis of chronic bronchitis (OR=0.41) and treatment of the exacerbation with moxifloxacin or amoxicillin­clavulanic acid as opposed to clarithromycin (OR=0.38) were associated with low-cost exacerbations. Conclusion: Treatment failure was reported for 21.8% of the patients with exacerbations of chronic bronchitis and COPD. Repeated medical visits and requests for complementary tests were the main factors responsible for increased cost. Variables associated with high-cost exacerbations were continuous oxygen therapy, previous hospitalization, and treatment with clarithromycin as opposed to moxifloxacin or amoxicillin- clavulanic acid

Epidemiology and global impact of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease that causes a heavy health and increasing economic burden both in the United States and around the world. Most of the risk factors for COPD are well known and include smoking, occupational exposures, air pollution, airway hyperresponsiveness, asthma, and certain genetic variations, although many questions, such as why a minority of smokers develop significant airway obstruction, remain. Major medical organizations have agreed on a common definition of COPD, although newer measures, such as functional status or exercise capability, have emerged as important in determining the prognosis of COPD patients. In most of the world, COPD prevalence and mortality are still increasing and will likely continue to rise in response to increases in smoking, particularly by women and adolescents. Resources aimed at smoking cessation and prevention, COPD education and early detection, and better treatment will be of the most benefit in our continuing efforts against this important cause of morbidity and mortality.

Health-related QOL in acute exacerbations of chronic bronchitis and chronic obstructive pulmonary disease: a review of the literature.

There is a lack of emphasis on health-related QOL (HR-QOL) changes associated with acute exacerbation of chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD). The aim of this review is to examine the use of HR-QOL instruments to evaluate acute exacerbation of CB or COPD, so as to form recommendations for future research.A literature search of papers published between 1966 and July 2003 identified more than 300 articles that used acute exacerbation of CB or COPD as the search term. However, only 21 of these studies employed HR-QOL measures as predictors of outcome or in the assessment of the impact, evolution or treatment of acute exacerbations of COPD or CB. A variety of HR-QOL measures were used, both generic and disease specific. The disease-specific St George's Respiratory Questionnaire (SGRQ), devised for patients with stable CB and with a recall period of 1-12 months, was the most widely used measure, with the Chronic Respiratory disease Questionnaire (CRQ) and the Baseline and Transitional Dyspnoea Index (BDI, TDI) being the only other disease-specific measures used. Most measures, both generic and disease specific, performed adequately when used during acute exacerbation of CB or COPD and indicated poor HR-QOL during acute exacerbation, which improved on resolution of the exacerbation. Relationships were evident between HR-QOL during an acute exacerbation and various outcomes, including post-exacerbation functional status, hospital re- admission for acute exacerbation or COPD, and mortality. There is a need for studies of treatments for acute exacerbation of CB or COPD to include an appropriate HR-QOL instrument to aid in the stratification of patients so as to target the right treatment to the right patient group. While a new instrument could be developed to measure HR-QOL during acute exacerbation of CB or COPD, currently available disease-specific measures such as the CRQ and the SGRQ appear to be acceptable to patients during acute exacerbation. However, the recall period of the SGRQ symptoms component should be shortened to make it more appropriate for use during acute exacerbation.

Análisis de los costes directos durante un año de pacientes con EPOC seguidos en una consulta neumológica extrahospitalaria / Direct cost analisis of patients with stable COPD in a neumology consult. One year follow up

FUNDAMENTO: La elevada prevalencia de la Enfermedad pulmonar obstructiva crónica (EPOC) en nuestro medio provoca un considerable gasto sanitario. PACIENTES Y METODO: Se realizó un estudio prospectivo desde los años 1996-1999 en el que se analizan los gastos derivados de costes directos (medicación, exploraciones complementarias y asistencia, que incluye atención médica e ingresos hospitalarios) en 336 pacientes con EPOC seguidos durante un año en una consulta extrahospitalaria de neumología, y su relación con el grado de afectación funcional respiratoria de los mismos. RESULTADOS: El gasto medio global fue de 893 € por paciente/año, distribuyéndose el mismo en un 46% (409€), debidos a los gastos en asistencia, 43% (384€) por medicación y el 11% (100) por técnicas complementarias. El gasto total y sus apartados de medicación y técnicas complementarias se correlacionó con peor situación funcional. Este hecho no ocurrió con el apartado de gasto por asistencia. CONCLUSIÓN: El coste directo en pacientes EPOC es elevado, siendo el mayor porcentaje debido a la asistencia. Los pacientes más deteriorados funcionalmente presentan mayores gastos, pero no necesariamente mayor coste por ingreso (AU)

INTRODUCTION: Chronic obstructive disease is a high prevalece disease which is increased with age and elevated cost. OBJETIVE: To estimate the direct medical cost of patients with chronic obstructive pulmonary disease(COPD) followed one year in a neumology consult, and the relationship with their respiratory function status. We perform a prospective study in 1996 which include 336 patients, and was analized the cost due to medications, diagnosis procedures and physician services. RESULTS: mean cost were 893 €, including 46% (409€), derived for physician services, 43% (384€) for medications and 11% for diagnosis procedures. The global cost and each part of medication cost and diagnosis procedures cost were related with a deteriorated funcional status but we don’t found this correlation with physician services costs. We didn’t found correlation of mayor cost with age. CONCLUSION: The cost due of patients with COPD is high, especially the percentage of physician services. The more deteriorated functional status the more cost, but it not included hospital care cost (AU)

Economic evaluation of the antibiotic treatment of exacerbations of chronic bronchitis and COPD in primary care.

This was an observational and economic survey performed in primary care practices throughout Spain to assess the effectiveness and direct medical costs derived from antibiotic treatment of exacerbations of chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD) in primary care. A total of 252 physicians included 1456 valid patients, 80% were male and the mean age was 68.2 years (SD = 9.8). The antibiotic treatment administered was moxifloxacin in 575 (39.5%), amoxicillin/clavulanate in 460 (31.6%) and clarithromycin in 421 (28.9%). No significant differences were found in clinical and demographic characteristics between treatment arms. The 30-days follow-up visit was completed by 1097 (75%) patients, who were therefore valid for economic evaluation. During follow-up, 440 new medical visits were generated, 69 patients required attendance in emergency wards (6.3%) and 22 were hospitalised (2%). The overall mean cost of exacerbation was Euro 118.58 [95% confidence interval (CI) = Euro 92.2-144.9] and Euro 52.44 (44.2%) were due to therapeutical failure. The mean cost of exacerbation was Euro 111.46 (95% CI = Euro 73.4-149.5) for patients treated with moxifloxacin, Euro 109.45 (95% CI = Euro 68.2-150.7) for those treated with amoxicillin/clavulanic acid and Euro 138.95 (95% CI = Euro 89.4-188.5) for patients receiving clarithromycin. In conclusion, a significant number of patients require new medical interventions after ambulatory treatment of exacerbations of CB or COPD. The mean cost of an exacerbation was Euro 118.58 and failure was responsible for 44.2% of the total cost of exacerbation.

[Pharmacoeconomic analysis of patients with acute exacerbation of chronic bronchitis treated with telithromycin or cefuroxime-axetil]. / Análisis farmacoeconómico del tratamiento de pacientes con exacerbación aguda de la bronquitis crónica con telitromicina o cefuroxima-axetilo.

INTRODUCTION: A pharmacoeconomic analysis was done to compare the efficiency of two treatments in the acute exacerbation of chronic bronchitis: telithromycin and cefuroxime-axetil. METHODS: Restrospective analysis, modeled through a decision tree. The effectiveness of the treatments was estimated through a randomized and double-blind clinical trial in which 800 mg/day (5 days) of telithromycin were compared with 1,000 mg/day (10 days) of cefuroxime-axetil in patients with acute exacerbation of chronic bronchitis (140 and 142 patients, respectively). Resources use was estimated from clinical trial and from Spanish data, and the unit costs through a health costs dabatase. The model was validated by a panel of Spanish clinical experts. RESULTS: Since the clinical trial was designed to demonstrate equivalence, there were no significant differences of effectiveness among both treatments (with a rate of clinical cure of 86.4% and 83.1%, respectively) which means that an analysis of costs minimization was done. In the average case, the average cost of the disease by patient was 174.83 Euros with telithromycin and 194.68 Euros with cefuroxime-axetil (a difference of 19.85 Euros). The results were maintained in the analysis of sensitivity, with favorable differences for telithromycin that ranged between 18.04 Euros and 22.25 Euros. CONCLUSIONS: With telithromycin up to 22 Euros by patient with acute exacerbation of chronic bronchitis could be saved, in comparison with cefuroxime-axetil.

The workplace impact of acute exacerbations of chronic bronchitis (AECB); A literature review.

Acute exacerbations of chronic bronchitis (AECB) are known to have a substantial economic burden in terms of medical care costs. The objective of this study was to assess workplace-based costs associated with AECB, including absenteeism and decreased productivity, based on a review of published literature. A secondary goal was to identify factors related to workplace-based costs in AECB. A literature search was conducted to identify relevant articles assessing one or more aspects of work loss or workplace costs among patients with chronic bronchitis. A review of the identified literature indicates that patients with chronic bronchitis had more days off work; patients whose exacerbations were treated were less likely to have additional exacerbations and had comparatively less work loss. Findings suggest that clinical outcomes and workplace costs are related. While this relationship is clearer in terms of work loss, further exploration is needed to assess decreased productivity and to evaluate this relationship using objective indicators of absenteeism and productivity rather than recall.

The economic impact of acute exacerbations of chronic bronchitis in the United States and Canada: a literature review.

BACKGROUND: Acute exacerbations of chronic bronchitis (AECB) are recurrent and potentially severe medical events for the 13 million people in the United States who have chronic bronchitis. Medical resource use associated with AECB can have a substantial economic impact on the patients, health care system, and society overall. OBJECTIVE: To evaluate literature on the economic impact of AECB in terms of cost of illness, cost of treatments, and cost-effectiveness. METHODS: A MEDLINE literature search was conducted for studies of chronic bronchitis and costs. Reference lists of identified articles were also retrieved for review. RESULTS: Eight published studies were identified: 2 cost-of-illness studies, 1 comparative cost study, and 5 cost-effectiveness studies. Important drivers of costs associated with AECB include hospitalization and choice of antibiotics. In mild to moderate AECB, patient adherence with therapy is essential to consider when selecting treatment. The antibiotic with the lowest acquisition cost has not been shown to be the most cost effective, as adherence and clinical outcomes, particularly rehospitalization rates, differ. CONCLUSION: Further research in these areas is needed to guide clinical decision making and the conduct of disease management programs.